FEEDING BREASTMILK other than at the breast

When the nursing parent and baby are separated or the baby cannot feed at the breast, they may need another way of taking breastmilk. These tips assume that your baby is being fed expressed breastmilk. If this is not available, please check with your baby’s healthcare provider.

when is the best time to introduce a bottle?

La Leche League’s The Womanly Art of Breastfeeding  manual suggests that unless it’s essential, ideally the introduction of a bottle is left until the baby is at least three to four weeks old, and breastfeeding well.   Milk supply can adjust to the baby’s needs more easily if he is able to breastfeed directly, and the more practice the baby gets at the breast, the more quickly he will become skilled at breastfeeding.

Some people worry that if they don’t introduce a bottle early on, the baby won’t take one later.  While a younger baby is slightly more likely to accept a bottle than an older one, it’s not a strong effect.  Most babies of all ages will accept a bottle – some with a little coaxing!  If you are thinking ahead to going back to work or study, but you won’t be doing this until your baby is older than 6 months, it may be reassuring to know that your baby probably won’t need a bottle by then.  He will already be eating other foods and drinking water, and could be offered milk in his usual cup.  Healthcare providers recommend that by a year, all babies (even those who have been completely bottle-fed) have stopped using bottles, because of their impact on teeth.

When a baby isn’t able to breastfeed at all, or isn’t able to take enough milk at the breast, it’s important to start expressing milk early and often, to protect your milk supply and keep your baby safely fed.  You can find information about this here. 

IDEAS FOR INTRODUCING A BOTTLE TO A BREASTFED BABY

If you would like to introduce a bottle, here are some ideas that have worked for other families:

• Choose a time when your baby is happy and relaxed, and not too hungry.  It’s difficult to learn a new skill when you’re hungry!  It can be helpful at first to think of it as a play activity, rather than a meal.
• Have someone else offer the bottle to your baby. A breastfed baby may be least likely to accept a bottle from his mother – he knows where he expects the milk to come from!  This doesn’t mean that he won’t accept an alternative when she isn’t available.  Even very young babies understand that different people care for them in different ways.  Often, the best person to give a bottle to a reluctant baby is an experienced, confident bottle-feeder.  Ideally, this will be someone who knows the baby well.  Limit the number of people feeding your baby to no more than two or three; feeding is an intimate process, and it’s important that your baby feels safe and comfortable, and that the feeder can get to know your baby’s preferences.
• Hold the baby comfortably, but not lying in the crook of your arm.  Babies who are bottle-fed lying on their backs can end up taking too much milk, too quickly.  Very young babies (under about 6 weeks) can be fed lying on their side, on a pillow on your lap, with their feet towards you.  Some younger babies, and most older babies feed best sitting up fairly straight, supported behind their neck and shoulders by your arm or hand.
• Gently present the bottle teat across the baby’s lips, to stimulate her gaping (mouth-opening) reflex and invite her to take the teat into her mouth.  You could gently tickle her lips with it, as many mothers do with the breast.  If she accepts it, give her a good mouthful, so she isn’t just sucking on the end of the teat.  Most babies do best with a teat that encourages them to open their mouth wide.
• Keep the bottle in a horizontal (flat) position, so the baby needs to suck actively to get the milk, as he does at the breast. This is often called “paced bottle feeding.” You will need to tip the bottle as it becomes emptier, so that there is milk the end of the teat, but the whole teat doesn’t need to be full of milk all the way through the feed.  Most babies do best with a slow-flow “newborn” teat; you might need to try a few different brands and teats to find one with a speed your baby likes (flow rate is not standardized across different brands).  It typically takes about 15-20 minutes to finish a bottle – there’s no rush.  Tilting the bottle to pour milk into the baby’s mouth can lead to him taking more milk than he needs, faster than he can easily manage. This can cause discomfort, as well as frustration when he returns to the breast and the flow of milk is slower.
• Watch for signs that the baby needs a break.  When breastfeeding, the baby waits for a few seconds up to a minute before the milk “ejects” in a rush, then gradually slows down, allowing natural pauses.  Bottle-feeding can be tiring for the baby, because she has to keep sucking at the same speed throughout the feed.  The following signs suggest she might need a rest: a wrinkled forehead (frown); wide, alarmed eyes as she gulps quickly; “starfish hands” (fingers splayed out); turning her head away from the bottle; suddenly going to sleep (not just gently drifting off as she becomes full and satisfied).   If you notice any of these stress signals, or if milk spills from her mouth, tip the bottle down to stop the flow, or take the bottle away, until she asks for more milk.  If she doesn’t ask for more, she has had enough for now.
• As at the breast, babies may want a feed that comes in two parts.  Young babies may want a short nap (often about 10-20 minutes) before taking the second part of their feed.  Most adults prefer always to give a bottle using the same hand, but you could even try turning her round to have some more on the “other side”!

help – my baby won’t take A BOTTLE!

It can feel really stressful when your baby won’t take a bottle, especially if you have a looming deadline, such as returning to work. You may have already tried some of the “usual” hints in the previous section – here are a few more:

• If the feeder isn’t the mother, they could try wrapping the bottle in something that smells of the mother, like a piece of her clothing, or a cloth that has been used to catch dripping milk.
• Some babies like to be bottle-fed skin to skin, in their favorite breastfeeding position.
• Other babies do better in a completely different position that doesn’t remind them of breastfeeding. You could try propping him in your lap with his back to your chest. He can watch what is going on in the room (or out of the window, or even go to a park or mall!) while drinking from the bottle.  Or prop the baby on your slanted forelegs, like in an infant seat, and offer the bottle face-to-face.
• Try to feed while moving rhythmically, calming the baby.  An outward or sideways-facing baby carrier can be useful for this (make sure you can see the baby’s face, to spot signs that he needs a break). Try rocking, swaying, or walking, or sitting in a rocking chair, a swivel chair, or an office chair on rollers
• Try different kinds of teats. Some babies like a softer teat designed for premature infants, or prefer a different length, width or rate of flow. Consult a healthcare provider for ideas about teats to try.
• Try varying the temperature of the teat. Put it in the refrigerator (teething babies like this) or run warm (not hot) water over it.
• Try varying the temperature of the milk. Breastmilk direct from the breast is lukewarm. Some babies prefer that temperature, while others prefer it at room temperature or even cold from the refrigerator.

If your baby is still unwilling to take a bottle, don’t panic!  Most babies will take one eventually, with a little coaxing.  Try again later, when he is in a relaxed, playful mood.  If you can, wait a few days.

A healthy, well-grown baby can manage without milk for several hours if necessary, and he may prefer to wait to feed until you get back after a short separation.  Just because your baby usually breastfeeds at a particular time doesn’t necessarily mean that he will need milk at that time if you aren’t there.  He may prefer some playtime, or a cuddle, or to be read or sung to, or soothed off to sleep in a stroller or sling.  If he really needs milk, he won’t starve himself if milk is available.  Babies are very smart!

With sensitivity to the baby’s needs, and a flexible attitude, the alternative caregiver will figure out ways of managing when you aren’t there.  Your baby knows that this isn’t you looking after her, and won’t expect them to do exactly what you usually do.  It might look even very different from what you usually do, but as long as she is safe and happy, that’s fine!

ALTERNATIVES TO BOTTLES

Most breastfed babies in the world never use a bottle, going straight from the breast to drinking from a cup.  And a few babies who are offered a bottle simply refuse to take one, whatever their parents and carers try!  Bottles are not the only alternative feeding method – there are lots of other options.

Even premature babies can drink from an open cup, with care and practice. Special cups are available, but any clean cup can work; some parents prefer a small one, such as a shot glass.

To cup feed:

• Sit your awake baby upright on your lap, supported behind her neck and shoulders by your arm or hand.
• Place the rim of the cup on her lower lip and tilt the cup until the milk approaches her lip. Her tongue will explore and find the liquid. She will then lap or sip the milk – on the first few attempts, this may take a few minutes. You might want to use a bib or cloth to catch spills, until you’ve got some experience of feeding this way! Don’t pour the milk into your baby’s mouth.  Keep the level constantly by her lower lip and allow her to rest and pause while drinking, but do not remove the cup.
• When she has finished, she will let you know by turning her head away, or by other obvious cues.
• To learn how to cup feed, try practicing with another adult first – you will quickly work out how far you need to tip the liquid to avoid frustration or spills!

Other feeding methods:

• For a tiny baby, other options for offering milk include a dropper, oral syringe or teaspoon.
• A baby who can breastfeed but needs extra milk as well could be fed using a nursing supplementer – a gadget that delivers milk via a tube that is taped or held next to your nipple.  The baby takes both breast and tube at the same time, and gets milk from the supplementer as he nurses at the breast.  Your LLL Leader can help you decide whether this might be a suitable option for you.
• Babies who can sit up may prefer to feed themselves (well supervised) from a regular cup or a “sippy cup”  with a lid.  If you are also breastfeeding, you may want to avoid models that rely on the baby biting or pressing firmly on a valve to get liquid out!
• Your baby may enjoy drinking milk from something he often sees you using, such as your favorite coffee mug – just make sure you wash the coffee out first!

When your baby is fed by one of these methods, be sure to breastfeed often when you are together, to satisfy your baby’s sucking need.

HOW MUCH MILK?

Most breastfed babies take about 60-120ml (2-4oz) of breastmilk per feed, from 1-6 months of life. The composition of breastmilk changes as the baby grows, but not necessarily the quantity taken at each feed. This is different from artificial milk, which the manufacturers suggest needs to be given in increasing volume, in line with the baby’s weight as he grows.  Some experts think that this leads to overfeeding, and may be one of the reasons why babies fed on formula milk are at higher risk of overweight and obesity in later life.  If you are feeding carefully, in a “paced” way (as described above), you can trust your baby to show you how much he wants at each feed.  It may be a quick drink or a full meal – just like adults, babies don’t need all their feeds to be the same size.  Make sure that your baby’s caregiver doesn’t give your baby a lot of milk shortly before you return, though; you will probably want to feed as soon as you arrive, to reconnect with your baby and relieve your breasts!

CHANGING FEEDING PATTERNS WHEN MOTHER AND BABY ARE APART

It’s common for breastfed babies to refuse a bottle initially when their mother returns to work or study, while they adjust to major changes such as a new daycare environment and caregivers.  Adults often feel less hungry when they first start a new job, too!  The baby’s appetite will come back as he settles into his new rhythm and gets to know his carers. Some babies may choose to “reverse cycle,” which means refusing a bottle or taking less milk than normal when away from mum, then nursing a lot when they are together.  Breastfeeding isn’t just about milk, of course; allow your baby to “fill up” on cuddles, as well as milk, as much as possible when you are together.  Give yourselves a week or two to adjust to your new pattern. As long as your baby’s diaper output and growth are normal, he’s getting enough milk. Babies older than about 6 months, who are also eating other foods, may choose to manage without milk altogether while you are away, managing fine with food and water until you get back.  Babies often surprise their mothers by eating much more when you aren’t there than they do at home, especially if other children are also eating!

WHEN OTHER PEOPLE WANT TO BOTTLE-FEED YOUR BABY

Often family members sometimes express a desire to bottle-feed a breastfed baby as a way of “bonding” with them.  They may be impressed by the powerful connection you are making with your breastfeeding baby, and want the same kind of closeness.  It can be helpful to know that what strengthens attachment is touch (especially skin-to-skin holding) and gaze (looking into each other’s eyes) –  not the transfer of milk.  Fathers, co-parents and other key adults who spend lots of time holding babies skin-to-skin and sharing gaze and smiles with them experience a surge of nurturing hormones, like breastfeeding mothers do.  If you want to promote a closer connection between your baby and the other important people in her life, encourage them to wear her in a sling, take a bath with her or just hang out together between breastfeeds, and let nature do its magic!

Even very young breastfeeding babies can have strong, loving relationships with several people at once, including other close adults and siblings.  But their mother is usually the center of the baby’s universe, and especially if they are tired, upset or unwell, there will be times when “only mom will do”.  Fathers and other close adults can feel frustrated and powerless, and wonder whether life might be easier for them if the baby weren’t breastfed.  Experienced parents know that these early months and years pass quickly, and the time will come when the baby or young child reaches out to someone else, in preference to their mother!  Older babies and toddlers typically go through cycles of intense connection with one favored parent or carer, then another.

In the meantime, there are many ways a loved one can help you and your baby at the same time.  They can love, listen to and support the breastfeeding parent. They can change a diaper. They can bathe the baby. They can hold and calm the baby when he is not hungry, especially in those evening hours when young babies often need long periods of intensive soothing. They can “babywear” and spend time skin to skin. They can play with, sing and read to the baby. They can bring mum a glass of water, snack, phone, TV remote, or anything else she needs when she sits down to nurse.. They can take care of housework, errands and meals. They can defend mum to others who may not support breastfeeding or other parenting choices. They can be right there next to mum when she breastfeeds in public, helping her feel confident.  They can contact a La Leche League Leader for help!  Bottles are not a necessary part of a close relationship with the baby.

DIFFERENCES BETWEEN FEEDING AT THE BREAST AND BEING BOTTLE-FED

Exclusive pumping (“EP”), when a baby is fed completely on his mother’s expressed breastmilk, is becoming more popular, for many reasons.  Most mothers who express all their milk for their baby have experienced such overwhelming breastfeeding challenges that breastfeeding directly does not feel like an option for them.  They invest precious time in milk expression so that their babies can still have the benefits of mother’s milk.  This is a true “labor of love”.

A few mothers may have the option of breastfeeding directly, but wonder whether expressing their milk and feeding by bottle isn’t just as good.  It may be helpful to know that there are some differences between direct breastfeeding and “breastmilk feeding” by other means.

• Your milk has the highest level of antibodies when your baby takes it directly from your breast, and next highest when it is freshly expressed. Your body responds to your baby’s saliva – if your baby is exposed to something that he needs antibodies for, this need is communicated to your body as your baby breastfeeds.
• The longer milk is stored, the more the active components are deactivated. Your refrigerated or frozen milk still provides excellent nutrition and protection for your baby, just not as much as directly from the breast or freshly expressed
• The activity of breastfeeding helps exercise the facial muscles. This promotes the development of strong jaws and balanced facial structure. Several studies have shown breastfeeding to enhance speech development and speech clarity. Increasing duration of breastfeeding is associated with decreasing risk of later need for braces or other orthodontic treatment. One study showed that overbites (malocclusion) requiring orthodontia could be cut in half if infants were breastfed for one year.
• Breastfeeding directly is also less time consuming – as any EP mother can tell you! There are no pump parts to wash, a skilled breastfeeding baby can remove milk faster than any pump, and the mother doesn’t need to spend extra time pumping and then feeding the expressed milk to her baby.  When the baby is hungry or needs to be comforted, you simply put your baby to the breast, without needing to prepare the bottle and warm the milk.

the benefits of skin to skin contact

Skin to skin contact provides a baby with huge benefits.  It increases the mother’s milk supply by helping her hormones to flow, and helps to “organise” the baby’s behaviour so that he learns to feed more easily. Babies who are held skin-to-skin cry less, saving their energy for growing, and have more stable breathing, heart rate, blood sugar, and temperature.

When you are breastfeeding, you have to be in skin-to-skin contact with your baby, even if you don’t feel like it!  And a baby at the breast is at the perfect distance for gazing at your face, basking in the warmth of your smile.  When a baby is fed partly or entirely by bottle (or any means other than the breast), they can still benefit from lots of skin contact, holding and gaze – carers just need to be more intentional about it.

Your baby might enjoy:

• Taking a bottle snuggled against your bare breast
• Falling asleep with his cheek pillowed on your breast at the end of a feed (some babies may be willing to use the breast to suck themselves peacefully off to sleep after a bottle-feed, even if they get most of their calories by bottle)
• Taking a bath with you
• Being “worn” in a sling or front carrier near the breast

La Leche League is all about mothering – not just breastfeeding.  While we believe that “mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby”, we know that when this isn’t an option, or can only be done some of the time, with care and thought, babies can be fed and mothered lovingly and responsively in other ways too.  We have supported thousands of mothers to provide human milk for their babies by means other than the breast, and to have wonderfully close, satisfying relationships with their babies.  You can too!

La Leche League groups welcome anyone who is pregnant, breastfeeding, providing their own milk, or donor milk, for a baby, or trying to do so. We also welcome those who are interested in the information we offer. Please don’t feel awkward about feeding your baby from a bottle or other means during an LLL meeting, or asking questions about it!  Breastfeeding mothers understand better than anyone else the challenges of breastfeeding, and the work involved in expressing milk.  We would love to meet you and your baby, and support you on your feeding journey.

Introducing a Bottle to a Breastfed Baby
Cup Feeding
Breastfeeding Is Love – an atypical story of breastfeeding
Milk Donation and Sharing

Published January 2019.